[Cytomegalovirus polyradiculomyelopathy in AIDS]. / Poliradiculomielopatia causada por citomegalovirus en pacientes con SIDA.

To evaluate the efficacy of ganciclovir, foscarnet, or the combination of both for the treatment of cytomegalovirus polyradiculomyelopathy (CMV-PRAM), we reviewed the records of seven patients with AIDS, diagnosed with CMV-PRAM. Muscle strength was graded according to the Medical Research Council (MRC) scale. Response to treatment was also classified according to MRC scale, based on the degree of improvement in muscle strength. Six of 7 patients had a good response to treatment, reaching the MRC scale of 4, or improving at least 3 degrees in the same scale. CMV-PRAM may be treated with ganciclovir alone or in combination with foscarnet.

Report of 24 cases of Listeria monocytogenes infection at the University of Miami Medical Center.

To examine the epidemiological spectrum of human listeriosis at a large municipal hospital in Miami, we reviewed the cases of Listeria monocytogenes infection seen at the University of Miami Medical Center over a nine-year period (1986-94). Twenty-four patients (13 adults, 11 neonates) with bacteriologically proven Listeria monocytogenes infections were identified. The annual rate of listeriosis for the entire period 1986-1994 was 0.042 cases/1,000 hospital admissions. The rates of listeriosis during the first half of the study period (0.0628/1,000 admissions) were three times higher than the rates observed during the second half of the study (0.0214/1,000 admissions). Four (57%) of the 7 adult cases of listeriosis seen after 1987 occurred in HIV-seropositive patients. Compared with the hospital population, the annual rates of listeriosis were several fold higher in patients post-renal transplant (4.65 cases/1,000 renal transplant-related admissions) and patients with HIV/AIDS (0.27 cases/1,000 HIV-related admissions). No deaths were recorded. The decline in the annual rate of listeriosis noted in our study parallels national trends recently reported by the Centers for Disease Control and Prevention.

Primary lymphoma of the liver in AIDS. Report of one new case and review of the literature.

A case of primary lymphoma of the liver in a patient with acquired immunodeficiency syndrome (AIDS) is presented. Persistent fever, tender hepatomegaly, and mildly abnormal liver function tests combined with an elevated lactate dehydrogenase level gave the clue for the diagnosis. High-grade, non-Hodgkin's lymphoma of B-cell phenotype was demonstrated by percutaneous liver biopsy. Primary hepatic lymphoma is a rare event among patients with AIDS. We reviewed the cases in the literature and noted that a preponderance of these patients presented with multiple lesions (a rather rare occurrence in primary lymphoma of the liver in patients not infected with the human immunodeficiency virus).

Contaminated stethoscopes revisited.

BACKGROUND: Because of their universal use by medical professionals, stethoscopes can be a source of nosocomial infections. OBJECTIVE: To determine the frequency of contamination of stethoscopes with bacteria and fungi. METHODS: Cultures were obtained from 200 stethoscopes from four area hospitals and outpatient clinics in Houston, Tex. The frequency of stethoscope contamination in different groups of hospital personnel and medical settings was determined. We also measured the frequency of antimicrobial resistance of the staphylococcal strains that were isolated. RESULTS: One hundred fifty-nine (80%) of the 200 stethoscopes surveyed were contaminated with microorganisms. The majority of organisms that were isolated were gram-positive bacteria, primarily Staphylococcus species. Fifty-eight percent of the Staphylococcus species that were isolated, including four (17%) of 24 Staphylococcus aureus isolates, were resistant to methicillin. Physicians' stethoscopes were contaminated more often than those of other medical personnel groups (P = .02). Stethoscopes used only in designated areas were contaminated less frequently than stethoscopes belonging to individual medical personnel (P = .01). Although stethoscopes were contaminated in all areas, stethoscopes from the pediatric medical setting were contaminated less frequently than those from other hospital areas (P = .009). CONCLUSIONS: Stethoscope use may be important in the spread of infectious agents, including antimicrobial-resistant strains, and strategies to reduce the contamination of stethoscopes should be developed. We recommend disinfection of stethoscopes or regular use of disposable stethoscope covers.

Methods for detection of an intestinal secretory immunoglobulin A response to Candida spp. and their preliminary application in human immunodeficiency virus-infected patients with chronic diarrhea.

Six of 11 human immunodeficiency virus (HIV)-infected patients with chronic diarrhea, shedding only Candida spp. in their stools, elicited a Candida-specific secretory immunoglobulin A response. Similar responses were identified in only 1 of 10 HIV-positive patients with chronic diarrhea but without Candida spp. and in none of 10 HIV-negative subjects without diarrhea. Candida spp. may play a role in the etiology of chronic diarrhea associated with HIV infection.

Tuboovarian abscess associated with Candida glabrata in a woman with an intrauterine device. A case report.

Candidal infection has been associated extensively with serious infections. Its role in genital tract infections has consisted largely of vulvovaginitis, with serious upper genital tract infection a rarity. A 47-year-old woman with an intrauterine device had Candida glabrata in a large tuboovarian abscess and recovered only after removal of the abscess and treatment with amphotericin B.

Nosocomial outbreak caused by a multiresistant clone of Acinetobacter baumannii: results of the case-control and molecular epidemiologic investigations.

OBJECTIVE: To describe a nosocomial outbreak caused by multiresistant Acinetobacter baumannii. DESIGN: Descriptive and case-control study. Antibiotic susceptibilities and pulsed-field gel electrophoresis (PFGE) of genomic DNA digested with SfiI and also with ApaI were used as markers of strain identity. SETTING: A large medical school-affiliated hospital in the city of Houston, Texas. RESULTS: During a 10-week period, A baumannii was isolated from 25 patients admitted to the intensive care unit (ICU). The attack rate was 14.3 per 100 ICU admissions. Case patients were intubated more frequently and for longer periods, and had longer ICU and hospital stays (P < 0.05 for each of these characteristics). Multivariate logistic regression analysis identified the length of ICU stay and the use of third-generation cephalosporins as associated with the acquisition of A baumannii. Patients infected with A baumannii had a higher mortality rate than colonized patients and control patients (P < 0.01). Sixteen isolates recovered from these 25 patients were susceptible only to imipenem/cilastatin, and PFGE confirmed that a single clone was the cause of this outbreak. Nine isolates of A baumannii from patients infected or colonized in two other hospitals in Houston during the same period, differed from the outbreak isolates by their susceptibility to ciprofloxacin. However, PFGE results were identical, indicating unsuscepted genetic relatedness among isolates from three different hospitals. CONCLUSIONS: A baumannii is an important nosocomial opportunistic pathogen and can adversely affect the outcome of ICU patients who acquire this organism. This outbreak was caused by a single clone that was isolated concurrently from three hospitals.

Shigella sonnei strains isolated from U.S. summer students in Guadalajara, Mexico, from 1986 to 1992.

Plasmid DNA analysis and antibiotic susceptibilities were used to study strains of Shigella sonnei isolated from U.S. travelers to Guadalajara, Mexico, over a period of seven years (1986 to 1992). One hundred sixty-one isolates were analyzed. By the use of cluster analysis, eight different plasmid profiles were identified during this interval. At any point in time, three to seven different plasmid profiles were present in this population. The introduction of strains that carried a new plasmid with a molecular mass of 5.1 MDa was coincidental with an increase in isolation of S. sonnei in 1988. This new plasmid was present in 87.5% of the isolates that were resistant to chloramphenicol. Shigellosis in Guadalajara follows a pattern of hyperendemic transmission with transient peaks of high-frequency isolation of S. sonnei. This pattern results from the concurrent presence of a heterogeneous group of strains as opposed to the widespread transmission of one or a few clones.

An unusual cause of acute renal failure: bilateral ureteral obstruction due to Candida tropicalis fungus balls.

Fungus balls have rarely been implicated as a cause of urinary tract obstruction. Approximately 50 cases of fungus balls of the urinary tract have been reported previously; the majority of cases were characterized by unilateral ureteral involvement or bladder involvement, and Candida albicans has been the organism most frequently isolated. We report, to our knowledge, the first case of bilateral ureteral obstruction caused by Candida tropicalis fungus balls.

Case report of spinal epidural abscess caused by Haemophilus paraphrophilus.

Haemophilus paraphrophilus was recovered in pure culture from purulent material collected at surgery from a patient presenting with a spinal epidural abscess and a severe neurological deficit. This is the first report of such an occurrence.